Healthcare Provider Details

I. General information

NPI: 1114895380
Provider Name (Legal Business Name): MADALYNN BROOKE BRADLEY ODOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 201
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

117 N ELM ST
LITTLE ROCK AR
72205-5539
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 479-305-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4157
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: